EXPLANATION: Drug abortion is becoming the newest GOP target
Drug abortion accounts for approximately 40% of all abortions in the United States. The increasingly popular method relies on pills rather than surgery, which opens up the possibility of having abortions at home rather than in a clinic. It’s an option that has become important during the COVID-19 pandemic.
While Republican states generally restrict access to abortions, many of them also restrict access to drug-induced abortions.
Vendors say drug abortion is safe and essential, especially as clinics become more difficult to access in Republican-controlled states.
HOW DOES DISCONTINUED MEDICINE WORK?
Drug abortion has been available in the US since 2000 when the Food and Drug Administration approved the use of mifepristone.
Stopping medication consists of taking mifepristone, waiting 24 to 48 hours, and then taking misoprostol. Mifepristone blocks the hormone progesterone, which is essential for maintaining a pregnancy. Misoprostol empties the uterus by causing cramping and bleeding.
The drugs are approved by the FDA for up to 10 weeks of pregnancy.
The method is considered highly effective and safe by health professionals. Pregnancies are terminated in more than 95% of cases and serious complications occur in 0.4% of cases.
According to the FDA, 3.7 million women aborted medication between 2000 and 2018. During this period, 24 women died after taking mifepristone.
The method’s popularity has grown steadily. The Guttmacher Institute, a research organization campaigning for the right to abortion, estimates that they account for about 40% of all abortions in the United States and 60% of abortions up to 10 weeks of pregnancy.
WHY IS IT IMPORTANT?
Proponents of abortion rights say the pandemic has shown the value of virtual health care, including the privacy and convenience of abortion taking place in a woman’s home rather than in a clinic.
Add to that its appeal: there are few clinics in several states where Republicans have passed strict laws restricting access. Mississippi, Missouri, North Dakota, South Dakota, and West Virginia are states that only have a single abortion clinic.
Abortion providers say as clinics become more difficult to access, drug abortions can allow women to perform abortions without the burden of travel, which can be especially difficult and expensive for women on lower incomes.
WHAT ARE STATES DOING TO LIMIT IT?
Opponents of abortion, worried abortion from drugs is becoming more common, pushing for laws in Republican-run states to restrict access to the drugs.
States have taken several measures to limit availability. These include banning the delivery of abortion pills by mail, shortening the 10-week window in which the method is allowed, and requiring women to take the pills in a clinic rather than at home.
Some states also require doctors to tell women undergoing drug-induced abortion that the process can be reversed in the middle, a claim that critics say is scientifically unsupported.
In 33 states, only doctors are allowed to give abortion pills. They can be provided by advanced practice physicians in 17 states and the District of Columbia.
Doctors providing the drug must be physically present when it is administered in 19 states, which means abortion patients cannot take the drugs at home.
Republican governors in Arkansas, Arizona, Montana, Oklahoma, and Texas signed laws banning the mailing of abortion drugs this year. Such laws were largely viewed in response to the increasing popularity of telemedicine during the pandemic.
The laws in Montana and Oklahoma are facing legal challenges. In Ohio, a judge temporarily blocked a law that would have banned the use of telemedicine for abortion pills while a legal challenge is pending.
Some Republican lawmakers also restrict the point during pregnancy at which drug termination can be provided. In Indiana and Montana, laws passed this year ban the drug after 10 weeks of pregnancy, and in Texas, a newly signed law bans the drug after seven weeks.
Texas law is due to come into effect in December. It was just passed when Texas began banning almost all abortions under a more far-reaching law known as Senate Law 8, which has become the nation’s largest abortion containment in half a century.
CAN ABORTIONS BE RETURNED DRUGS?
Eight states are demanding counseling to promote the idea that high-dose progesterone drug discontinuation can be reversed after taking mifepristone. The American College of Obstetricians and Gynecologists does not endorse the prescription of progesterone for this use and says the reversal claim is not based on scientific evidence.
Such laws are in effect in Arkansas, Idaho, Kentucky, Louisiana, Nebraska, South Dakota, Utah, and West Virginia. Lawsuits in Indiana, North Dakota, Oklahoma, and Tennessee have blocked enforcement of these counseling requirements. In Montana, the law is due to come into force on October 1, but is being challenged in court.
WHAT ARE THE FEDERAL RULES?
At the start of the coronavirus pandemic, the Food and Drug Administration – by order of a federal court – relaxed restrictions on abortion pills so they could be mailed.
But the FDA and its parent health agency under the Trump administration later argued that the rules were necessary to ensure the pills are used safely. The rule requires patients to collect the individual mifepristone tablet from a hospital, clinic, or doctor’s office and sign a form that includes information about the potential risks of the drug.
The Association of Obstetricians and Gynecologists sued the regulation and sparked a number of conflicting court rulings.
Last April, the FDA reaffirmed that women seeking an abortion pill will not need to see a doctor’s office during the COVID-19 pandemic. The policy change only applies in states where there are no laws that prohibit the use of telemedicine or require the presence of a doctor while taking the medication.
Also, the FDA guideline only applies as long as the COVID-19 health emergency continues. Several medical organizations are pushing to make drug abortion permanently available through online prescriptions and mail order pharmacies.
WHAT ARE THE OPTIONS FOR WOMEN?
Aid Access is one of several online initiatives that offer women abortion pills to be sent by post. It is led by Dr. Rebecca Gomperts, a Dutch doctor.
The FDA, then under the Trump administration, sent a letter to Aid Access more than two years ago urging it to cease operations, but the online drug company continued to send abortion pills to patients in the United States
The legality of the practice is ambiguous, but groups like Plan C, which aims to raise awareness about self-directed abortions, provide information on where and how the drugs can be obtained online.
These groups say such access is especially important for women in places where abortion clinics are subject to constant attack by anti-abortion advocates and where lawmakers and governors make it increasingly difficult for clinics to stay open.
If / When / How, a legal aid group on reproductive rights, has prosecuted 24 cases since 2000 of women being prosecuted for self-administered abortions.
“It is possible that someone could be targeted for investigation or arrest or prosecution even when there is no law that actually makes it illegal,” said Sara Ainsworth, the group’s policy director.